Lyme-related Tinnitus and Ear Fullness

Patients often ask me whether Lyme disease can cause tinnitus or ear fullness. The answer is yes — Lyme tinnitus and ear fullness are well-recognized presentations. Many patients describe ringing or hissing sounds, fluctuating pressure, crackling sensations, a feeling of water trapped in the ear, distorted sound perception, and hypersensitivity to everyday noise.

When examinations and audiograms return normal, patients are frequently reassured that nothing is wrong. Yet the underlying mechanisms are neurologic, inflammatory, immune-driven, and autonomic.

What Causes Tinnitus and Ear Fullness in Lyme Disease?

Several overlapping pathways converge to generate these auditory symptoms. Lyme can irritate the vestibulocochlear nerve, producing ringing or pressure sensations even in the absence of visible abnormalities. Autonomic dysfunction — common in Lyme, POTS, and dysautonomia — leads to a subjective sensation of blockage despite clear anatomy. Clinically, these pathways do not exist in isolation — many patients experience a blend of them.

Borrelia can also influence microvascular regulation, altering inner-ear perfusion. Some patients develop migraine-related auditory profiles marked by sound sensitivity, fullness, or fluctuating pressure, often without headache. Emerging research suggests that mast-cell-related pathways may also contribute.

In my practice, mast-cell-type reactions such as flushing, food intolerance, noise sensitivity, and ear pressure frequently overlap with Lyme presentations.

Patient Case

One patient came to us with ringing in the ears, a feeling of pressure, food sensitivities, and occasional flushing. Routine ENT and allergy tests didn’t reveal a cause. After we treated her Lyme disease and a related co-infection, her infection and autonomic symptoms improved — and her tinnitus, ear fullness, and mast-cell-type reactions improved as well.

Her story reflects a pattern we see in some patients: symptoms that look like MCAS can sometimes settle down when the underlying infection is treated. In these cases, the reactions may be less like a separate allergy condition and more like the immune system being thrown off balance by Lyme disease.

How Symptoms Present Clinically

Across my practice, I repeatedly see three presentations of Lyme tinnitus and ear fullness.

1. Ringing that worsens or fluctuates during treatment (likely reflecting shifts in inflammation or die-off reactions);
2. Ears that feel blocked even though testing remains normal (reflecting autonomic signaling issues rather than structural pathology);
3. Noise sensitivity or sound distortion (common noises are sharp, echoing, or vibrating — a form of hyperacusis tied to neurologic and immune dysregulation).

These mechanisms help explain why Lyme-related ear symptoms can persist even when imaging and ENT testing are normal.

What Helps Patients With Lyme Tinnitus and Ear Fullness?

Because multiple pathways contribute, treatment usually requires addressing infection, immune signals, and autonomic imbalance rather than focusing solely on the ear.

Improvement often follows antimicrobial therapy when indicated, autonomic stabilization strategies for POTS or dysautonomia, management of migraine-related phenotypes, sleep optimization, mast-cell-modulating care when appropriate, and treatment of co-infections such as Babesia or Bartonella.

Many patients — including the one described above — notice ringing, pressure, and sound sensitivity diminish as inflammation and autonomic signaling stabilize.

Clinical Takeaway

Tinnitus and ear fullness from Lyme disease have real biological causes — and in many cases, they can improve.

The mechanisms include nerve irritation, autonomic dysfunction, vascular instability, migraine variants, and immune activation — including emerging mast-cell-related pathways. When these contributors are identified and addressed, many patients experience meaningful improvement.

Have you experienced tinnitus or ear pressure with Lyme disease?

Resources

Journal of Clinical Medicine (2021) Association between Sudden Sensorineural Hearing Loss and Lyme Disease

Journal of Audiology and Otology (2023) Isolated Sudden Bilateral Neurosensory Hearing Loss as a Presentation of Lyme Neuroborreliosis 

CDC. Signs and Symptoms of Untreated Lyme Disease 

Dr. Daniel Cameron: Lyme Science Blog. Study finds hearing loss and tinnitus common in patients with tick-borne diseases

Dr. Daniel Cameron: Lyme Science Blog. Lyme disease patient with permanent tinnitus and hearing loss